Post-transplant malignancy:Focusing on virus-associated etiologies,pathogenesis,evidence-based management algorithms,present status of adoptive immunotherapy and future directions

Modern immunosuppression has led to a decrease in rejection rates and improved survival rates after solid organ transplantation.Increasing the potency of immunosuppression promotes post-transplant viral infections and associated cancers by impairing immune response against viruses and cancer immunoediting.This review reflects the magnitude,etiology and immunological characteristics of various virus-related post-transplant malignancies,emphasizing the need for future research.A multidisciplinary and strategic approach may serve best but overall literature evidence targeting it is sparse.However,the authors attempted to provide a more detailed update of the literature consensus for the prevention,diagnosis,management and surveillance of post-transplant viral infections and associated malignancies,with a focus on the current role of adoptive immunotherapy and the way forward.In order to achieve long-term patient and graft survival as well as superior post-transplant outcomes,collaborative research on holistic care of organ recipients is imperative.

An Evidence-Based Management Approach to HIV/AIDS in Nigeria

Objectives: This paper seeks to examine the history of HIV/AIDS in Nigeria while presenting a clear picture of some of the issues that exist in service delivery. Lastly, this paper explores how an evidence-based management approach offers an effective set of tools to HIV/AIDS organizations. Methods: Content analysis and a qualitative desk review of the literature. Results: Findings from this paper reveal that through the use of evidence-based management, preconceived notions can be challenged so as to yield a diversity of thought and a more people-centered approach to public health delivery. This paper also shows that in the Nigerian setting, an evidence-based management framework can be a transformative tool in ensuring that key populations can receive critical care and treatment in the long run despite the uncertainty that might exist when it comes to funding and resources. Conclusions: Evidence-based management is a rigorous framework that can be used for understanding how a multitude of factors can position an organization to achieve its theory of change, which in turn can lead to sustainable impact in the long run. Incorporating the use of evidence in everyday organizational behavior involves not only looking at the manner in which data is aggregated, but also how it is disseminated. In order to ensure that the evidence is not manipulated, nonprofit organizations are often viewed as being best suited for collecting evidence since they are not heavily plagued by systemic corruption and political tides, compared to their government counterparts.

The Effect of Evidence-based Management on Occupational Protection of Nurses Who Perform Chemotherapy

Objective:The study was to explore the effect of evidence-based management in occupational protection for nurses who perform chemotherapy.Methods:40 chemotherapy nurses were selected,20 of them were included in the experimental group for evidence-based management,and the other 20 were included in the control group for routine management.Results:Compared with the control group,there were significantly fewer adverse nursing events in the experimental group,and P<0.05.Conclusion:The effect of evidence-based management in occupational protection of nurses who perform chemotherapy is significant.

Multidisciplinary and evidence-based management of fistulizing perianal Crohn's disease

Perianal symptoms are common in patients with Crohn's disease and cause considerable morbidity. The etiology of these symptoms include skin tags, ulcers, fissures, abscesses, fistulas or stenoses. Fistula is the most common perianal manifestation. Multiple treatment options exist although very few are evidence-based. The phases of treatment include: drainage of infection, assessment of Crohn's disease status and fistula tracts, medical therapy, and selective operative management. The impact of biological therapy on perianal Crohn's disease is uncertain given that outcomes are conflicting. Operative treatment to eradicate the fistula tract can be attempted once infection has resolved and Crohn's disease activity is controlled. The operative approach should be tailored according to the anatomy of the fistula tract. Definitive treatment is challenging with medical and operative treatment rarely leading to true healing with frequent complications and recurrence. Treatment success must be weighed against the risk of complications, specially anal sphincter injury. A full understanding of the etiology and all potential therapeutic options is critical for success. Multidisciplinary management of fistulizing perianal Crohn's disease is crucial toimprove outcomes.

Intelligent Evidence-Based Management for Data Collection and Decision-Making Using Algorithmic Randomness and Active Learning

We describe here a comprehensive framework for intelligent information management (IIM) of data collection and decision-making actions for reliable and robust event processing and recognition. This is driven by algorithmic information theory (AIT), in general, and algorithmic randomness and Kolmogorov complexity (KC), in particular. The processing and recognition tasks addressed include data discrimination and multilayer open set data categorization, change detection, data aggregation, clustering and data segmentation, data selection and link analysis, data cleaning and data revision, and prediction and identification of critical states. The unifying theme throughout the paper is that of “compression entails comprehension”, which is realized using the interrelated concepts of randomness vs. regularity and Kolmogorov complexity. The constructive and all encompassing active learning (AL) methodology, which mediates and supports the above theme, is context-driven and takes advantage of statistical learning, in general, and semi-supervised learning and transduction, in particular. Active learning employs explore and exploit actions characteristic of closed-loop control for evidence accumulation in order to revise its prediction models and to reduce uncertainty. The set-based similarity scores, driven by algorithmic randomness and Kolmogorov complexity, employ strangeness / typicality and p-values. We propose the application of the IIM framework to critical states prediction for complex physical systems;in particular, the prediction of cyclone genesis and intensification.

Factors influencing the continuity of evidence-based practice in perioperative airway management for elderly patients with fractures:A qualitative study

BACKGROUND More and more evidence-based practices are emerging,but researchers mostly focus on short-term effects,resulting in evidence-based practices not being applied in the clinic in the long term.In this study,we took the evidence-based practice of perioperative airway management in elderly fracture patients as an example and adopted a descriptive phenomenological approach to understand the influencing factors of its sustainability to provide a reference basis for promoting the continuity of evidence-based practice in the clinic.AIM To explore factors influencing the persistence of evidence-based practice in perioperative airway management in elderly patients with fractures.METHODS This study was qualitative research.Nine nurses who implemented evidencebased practice in the orthopedic ward of a tertiary comprehensive hospital in Shanghai from September 2023 to October 2023 were selected using purposive sampling as research subjects.Semi-structured interviews were conducted with them,and the data were analyzed using the Colaizzi phenomenological analysis method based on the three dimensions and ten factors of the NHS sustainability model.RESULTS Three main themes and ten subthemes were identified:Process aspects(benefits to patients,benefits to nurses,lack of follow-up,complex processes);staff aspects(insufficient human resources,inadequate training and education,lack of leadership support);and organizational environment aspects(inadequate infrastructure,poor patient compliance,poor doctor cooperation).CONCLUSION Human resources,training and education,leadership support,infrastructure,and patient-physician collaboration are important factors influencing the sustainability of evidence-based practice for perioperative airway management in older patients with fractures.

Research on the Application of Evidence-Based Quality Control Circle to Improve the Implementation Rate of Airway Management Measures in Adult Critically Ill Patients

Objective: To explore the effect of evidence-based quality control circle (QCC) in improving the implementation rate of airway management measures in adult critically ill patients. Methods: Based on the Joanna Briggs Institute (JBI) evidence-based health care model, the best evidence of airway management in adult critically ill patients was obtained and applied to the clinic. Results: The total implementation rate of airway management measures in adult critically ill patients increased from 23.62% before the implementation of quality control circle to 88.82%, and the pulmonary infection rate in critically ill patients decreased from 42.31% to 21.74%, with statistical significance between the two groups (P 0.05). Conclusion: Evidence-based quality control circle activities can standardize the practice standards of airway management in critically ill patients, reduce the occurrence of patients’ airway related complications, and improve clinical outcomes.

Clinical Practice of Evidence-Based PDCA Cycle Management Model in Accelerated Recovery of Lung Cancer Patients

Objective: To explore the nursing effect of evidence-based PDCA cycle management mode in accelerated rehabilitation of patients undergoing thoracoscopic lung cancer radical surgery. Methods: 104 patients who underwent thoracoscopic lung cancer radical surgery in our hospital from June 2022 to February 2023 were randomly divided into control group and intervention group, with 52 cases in each group. The control group implemented evidence-based ERAS clinical pathway management, while the intervention group implemented evidence-based PDCA cycle quality management. The postoperative recovery of the two groups of patients was compared. Results: The postoperative recovery of the intervention group was significantly better than that of the control group. The first time to get out of bed, the first time to eat, the duration of chest drainage tube placement, and the length of hospital stay were significantly shorter than those of the control group. The incidence of postoperative chest complications and hospitalization costs were significantly lower than those of the control group, and patient satisfaction was significantly higher than that of the control group (P Conclusion: Evidence-based PDCA cycle quality management mode can effectively improve the implementation quality of accelerated rehabilitation nursing for patients undergoing thoracoscopic lung cancer radical surgery, and it is worthy of clinical promotion.

Patient satisfaction and follow-up adherence to glaucoma case management clinic in China

AIM:To assess glaucoma patient satisfaction and follow-up adherence in case management and identify associated predictors to improve healthcare quality and patient outcomes.METHODS:In this cross-sectional study,a total of 119 patients completed a Patient Satisfaction Questionnaire-18 and a sociodemographic questionnaire.Clinical data was obtained from the case management system.Follow-up adherence was defined as completing each follow-up within±30d of the scheduled time set by ophthalmologists during the study period.RESULTS:Average satisfaction scored 78.65±7,with an average of 4.39±0.58 across the seven dimensions.Age negatively correlated with satisfaction(P=0.008),whilst patients with follow-up duration of 2 or more years reported higher satisfaction(P=0.045).Multivariate logistics regression analysis revealed that longer follow-up durations were associated with lower follow-up adherence(OR=0.97,95%CI,0.95-1.00,P=0.044).Additionally,patients with suspected glaucoma(OR=2.72,95%CI,1.03-7.20,P=0.044)and those with an annual income over 100000 Chinese yuan demonstrated higher adherence(OR=5.57,95%CI,1.00-30.89,P=0.049).CONCLUSION:The case management model proves effective for glaucoma patients,with positive adherence rates.The implementation of this model can be optimized in the future based on the identified factors and extended to glaucoma patients in more hospitals.

Personal Thermal Management by Radiative Cooling and Heating

Maintaining thermal comfort within the human body is crucial for optimal health and overall well-being.By merely broadening the setpoint of indoor temperatures,we could significantly slash energy usage in building heating,ventilation,and air-conditioning systems.In recent years,there has been a surge in advancements in personal thermal management(PTM),aiming to regulate heat and moisture transfer within our immediate surroundings,clothing,and skin.The advent of PTM is driven by the rapid development in nano/micro-materials and energy science and engineering.An emerging research area in PTM is personal radiative thermal management(PRTM),which demonstrates immense potential with its high radiative heat transfer efficiency and ease of regulation.However,it is less taken into account in traditional textiles,and there currently lies a gap in our knowledge and understanding of PRTM.In this review,we aim to present a thorough analysis of advanced textile materials and technologies for PRTM.Specifically,we will introduce and discuss the underlying radiation heat transfer mechanisms,fabrication methods of textiles,and various indoor/outdoor applications in light of their different regulation functionalities,including radiative cooling,radiative heating,and dual-mode thermoregulation.Furthermore,we will shine a light on the current hurdles,propose potential strategies,and delve into future technology trends for PRTM with an emphasis on functionalities and applications.

Overview of the immunological mechanisms in hepatitis B virus reactivation:Implications for disease progression and management strategies

Hepatitis B virus(HBV)reactivation is a clinically significant challenge in disease management.This review explores the immunological mechanisms underlying HBV reactivation,emphasizing disease progression and management.It delves into host immune responses and reactivation’s delicate balance,spanning innate and adaptive immunity.Viral factors’disruption of this balance,as are interac-tions between viral antigens,immune cells,cytokine networks,and immune checkpoint pathways,are examined.Notably,the roles of T cells,natural killer cells,and antigen-presenting cells are discussed,highlighting their influence on disease progression.HBV reactivation’s impact on disease severity,hepatic flares,liver fibrosis progression,and hepatocellular carcinoma is detailed.Management strategies,including anti-viral and immunomodulatory approaches,are critically analyzed.The role of prophylactic anti-viral therapy during immunosuppressive treatments is explored alongside novel immunotherapeutic interventions to restore immune control and prevent reactivation.In conclusion,this compre-hensive review furnishes a holistic view of the immunological mechanisms that propel HBV reactivation.With a dedicated focus on understanding its implic-ations for disease progression and the prospects of efficient management stra-tegies,this article contributes significantly to the knowledge base.The more profound insights into the intricate interactions between viral elements and the immune system will inform evidence-based approaches,ultimately enhancing disease management and elevating patient outcomes.The dynamic landscape of management strategies is critically scrutinized,spanning anti-viral and immunomodulatory approaches.The role of prophylactic anti-viral therapy in preventing reactivation during immunosuppressive treatments and the potential of innovative immunotherapeutic interventions to restore immune control and proactively deter reactivation.

Heat transfer enhanced inorganic phase change material compositing carbon nanotubes for battery thermal management and thermal runaway propagation mitigation

Developing technologies that can be applied simultaneously in battery thermal management(BTM)and thermal runaway(TR)mitigation is significant to improving the safety of lithium-ion battery systems.Inorganic phase change material(PCM)with nonflammability has the potential to achieve this dual function.This study proposed an encapsulated inorganic phase change material(EPCM)with a heat transfer enhancement for battery systems,where Na_(2)HPO_(4)·12H_(2)O was used as the core PCM encapsulated by silica and the additive of carbon nanotube(CNT)was applied to enhance the thermal conductivity.The microstructure and thermal properties of the EPCM/CNT were analyzed by a series of characterization tests.Two different incorporating methods of CNT were compared and the proper CNT adding amount was also studied.After preparation,the battery thermal management performance and TR propagation mitigation effects of EPCM/CNT were further investigated on the battery modules.The experimental results of thermal management tests showed that EPCM/CNT not only slowed down the temperature rising of the module but also improved the temperature uniformity during normal operation.The peak battery temperature decreased from 76℃to 61.2℃at 2 C discharge rate and the temperature difference was controlled below 3℃.Moreover,the results of TR propagation tests demonstrated that nonflammable EPCM/CNT with good heat absorption could work as a TR barrier,which exhibited effective mitigation on TR and TR propagation.The trigger time of three cells was successfully delayed by 129,474 and 551 s,respectively and the propagation intervals were greatly extended as well.

Whole-process case management effects on mental state and selfcare ability in patients with liver cancer

BACKGROUND Regarding the incidence of malignant tumors in China,the incidence of liver cancer ranks fourth,second only to lung,gastric,and esophageal cancers.The case fatality rate ranks third after lung and cervical cancer.In a previous study,the whole-process management model was applied to patients with breast cancer,which effectively reduced their negative emotions and improved treatment adherence and nursing satisfaction.METHODS In this single-center,randomized,controlled study,60 randomly selected patients with liver cancer who had been admitted to our hospital from January 2021 to January 2022 were randomly divided into an observation group(n=30),who received whole-process case management on the basis of routine nursing mea-sures,and a control group(n=30),who were given routine nursing measures.We compared differences between the two groups in terms of anxiety,depression,the level of hope,self-care ability,symptom distress,sleep quality,and quality of life.RESULTS Post-intervention,Hamilton anxiety scale,Hamilton depression scale,memory symptom assessment scale,and Pittsburgh sleep quality index scores in both groups were lower than those pre-intervention,and the observation group had lower scores than the control group(P<0.05).Herth hope index,self-care ability assessment scale-revision in Chinese,and quality of life measurement scale for patients with liver cancer scores in both groups were higher than those pre-intervention,with higher scores in the observation group compared with the control group(P<0.05).CONCLUSION Whole-process case management can effectively reduce anxiety and depression in patients with liver cancer,alleviate symptoms and problems,and improve the level of hope,self-care ability,sleep quality,and quality of life,as well as provide feasible nursing alternatives for patients with liver cancer.

Systematic review of risk factors,prognosis,and management of colorectal signet-ring cell carcinoma

BACKGROUND Colorectal signet-ring cell carcinoma(CSRCC)is a rare clinical entity which accounts for approximately 1%of all colorectal cancers.Although multiple studies concerning this specific topic have been published in the past decades,the pathogenesis,associated risk factors,and potential implications on treatment are still poorly understood.Besides the low incidence,historically confusing histological criteria have resulted in confusing data.Nevertheless,the rising incidence of CSRCC along with relatively young age at presentation and associated dismal prognosis,highlight the actual interest to synthesize the known literature regarding CSRCC.AIM To provide an updated overview of risk factors,prognosis,and management of CSRCC.METHODS A literature search in the MEDLINE/PubMed database was conducted with the following search terms used:‘Signet ring cell carcinoma’and‘colorectal’.Studies in English language,published after January 1980,were included.Studies included in the qualitative synthesis were evaluated for content concerning epidemiology,risk factors,and clinical,diagnostic,histological,and molecular features,as well as metastatic pattern and therapeutic management.If possible,presented data was extracted in order to present a more detailed overview of the literature.RESULTS In total,67 articles were included for qualitative analysis,of which 54 were eligible for detailed data extraction.CSRCC has a reported incidence between 0.1%-2.4%and frequently presents with advanced disease stage at the time of diagnosis.CSRCC is associated with an impaired overall survival(5-year OS:0%-46%)and a worse stagecorrected outcome compared to mucinous and not otherwise specified adenocarcinoma.The systematic use of exploratory laparoscopy to determine the presence of peritoneal metastases has been advised.Surgery is the mainstay of treatment,although the rates of curative resection in CSRCC(21%-82%)are lower compared to those in other histological types.In case of peritoneal metastasis,cytoreductive surgery with hyperthermic intraperitoneal chemotherapy should only be proposed in selected patients.CONCLUSION CSRCC is a rare clinical entity most often characterized by young age and advanced disease at presentation.As such,diagnostic modalities and therapeutic approach should be tailored accordingly.

Clinical value of precise rehabilitation nursing in management of cerebral infarction

BACKGROUND Cerebral infarction,previously referred to as cerebral infarction or ischemic stroke,refers to the localized brain tissue experiencing ischemic necrosis or softening due to disorders in brain blood supply,ischemia,and hypoxia.The precision rehabilitation nursing model for chronic disease management is a continuous,fixed,orderly,and efficient nursing model aimed at standardizing the clinical nursing process,reducing the wastage of medical resources,and improving the quality of medical services.AIM To analyze the value of a precise rehabilitation nursing model for chronic disease management in patients with cerebral infarction.METHODS Patients(n=124)admitted to our hospital with cerebral infarction between November 2019 and November 2021 were enrolled as the study subjects.The random number table method was used to divide them into a conventional nursing intervention group(n=61)and a model nursing intervention group(n=63).Changes in the nursing index for the two groups were compared after conventional nursing intervention and precise rehabilitation intervention nursing for chronic disease management.RESULTS Compared with the conventional intervention group,the model intervention group had a shorter time to clinical symptom relief(P<0.05),lower Hamilton Anxiety Scale and Hamilton Depression Scale scores,a lower incidence of total complications(P<0.05),a higher disease knowledge mastery rate,higher safety and quality,and a higher overall nursing satisfaction rate(P<0.05).CONCLUSION The precision rehabilitation nursing model for chronic disease management improves the clinical symptoms of patients with cerebral infarction,reducing the incidence of total complications and improving the clinical outcome of patients,and is worthy of application in clinical practice.

Design and analysis of an advanced thermal management system for the solar close observations and proximity experiments spacecraft

In this paper,the mission and the thermal environment of the Solar Close Observations and Proximity Experiments(SCOPE)spacecraft are analyzed,and an advanced thermal management system(ATMS)is designed for it.The relationship and functions of the integrated database,the intelligent thermal control system and the efficient liquid cooling system in the ATMS are elaborated upon.For the complex thermal field regulation system and extreme space thermal environment,a modular simulation and thermal field planning method are proposed,and the feasibility of the planning algorithm is verified by numerical simulation.A solar array liquid cooling system is developed,and the system simulation results indicate that the temperatures of the solar arrays meet the requirements as the spacecraft flies by perihelion and aphelion.The advanced thermal management study supports the development of the SCOPE program and provides a reference for the thermal management in other deep-space exploration programs.

Application of Specialized Group Management in the Quality Control of Perioperative Nursing

Objective:To explore the role of specialized group management in the quality control of perioperative nursing.Methods:45 surgical nurses from our hospital were selected as the research subjects.Traditional operating room management was adopted from July 2019 to June 2020,and specialized group management was adopted from July 2020 to June 2021.The surgeon’s satisfaction,surgical nurses’core professional competence,and surgical patients’satisfaction were obtained through surveys and the results were analyzed.Results:Surgeon satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Besides,surgical nurses’core professional competency scores before the implementation of specialized group management were significantly lower than after its implementation(P<0.05).Lastly,surgical patients’satisfaction before the implementation of specialized group management was significantly lower than after its implementation(P<0.05).Conclusion:Specialized group management helps to improve the quality of perioperative care and should be applied in clinical practice.

The Chinese guideline for management of snakebites

In 2009,the World Health Organization included snakebite on the list of neglected tropical diseases,acknowledging it as a common occupational hazard for farmers,plantation workers,and others,causing tens of thousands of deaths and chronic physical disabilities every year.This guideline aims to provide practical information to help clinical professionals evaluate and treat snakebite victims.These recommendations are based on clinical experience and clinical research evidence.This guideline focuses on the following topics:snake venom,clinical manifestations,auxiliary examination,diagnosis,treatments,and prevention.

Estimation of the Direct Cost of Management of Venous Thromboembolism in Three Reference Hospitals in the City of Yaoundé: A Retrospective Study over a Three-Year Period

Background: Venous thromboembolism (VTE) is a major public health problem due to its increasing frequency, mortality and management cost. This cost may require major financial efforts from patients, especially in developing countries like ours where less than 7% of the population has health insurance. This study aimed to estimate the direct cost of managing VTE in three reference hospitals in Yaoundé. Methods: This was a cross-sectional retrospective study over a three-year period (from January 1st 2018 to December 31 2020) carried out in the Cardiology departments of the Central and General Hospitals, and the Emergency Centre of the city of Yaoundé. All patients managed during the study period for deep vein thrombosis and pulmonary embolism confirmed by venous ultrasound coupled with Doppler and computed tomography pulmonary angiography respectively were included. For each patient, we collected sociodemographic and clinical data as well as data on the cost of consultation, hospital stay, workups and medications. These data were analysed using SPSS version 23.0. Results: A total of 92 patient’s records were analysed. The median age was 60 years [48 - 68] with a sex ratio of 0.53. The median direct cost of management of venous thromboembolism was 766,375 CFAF [536,455 - 1,029,745] or $1415 USD. Management of pulmonary embolism associated with deep vein thrombosis was more costly than isolated pulmonary embolism or deep vein thrombosis. Factors influencing the direct cost of management of venous thromboembolism were: hospital structure (p = 0.015), health insurance (p 0.001), type of pulmonary embolism (p = 0.021), and length of hospital stay (p = 0.001). Conclusion: Management of VTE is a major financial burden for our patients and this burden is influenced by the hospital structure, health insurance, type of pulmonary embolism and length of hospital stay.

Current state and influencing factors in airbag management among emergency department nurses:A multicenter study

BACKGROUND The emergency department(ED)plays a critical role in establishing artificial airways and implementing mechanical ventilation.Managing airbags in the ED presents a prime opportunity to mitigate the risk of ventilator-associated pneumonia.Nonetheless,existing research has largely overlooked the understanding,beliefs,and practical dimensions of airway airbag management among ED nurses,with a predominant focus on intensive care unit nurses.AIM To investigate the current status of ED nurses'knowledge,beliefs,and practical behaviors in airway airbag management and their influencing factors.METHODS A survey was conducted from July 10th to August 10th,2023,using convenience sampling on 520 ED nurses from 15 tertiary hospitals and 5 sary hospitals in Shanghai.Pathway analysis was utilized to analyze the influencing factors.RESULTS The scores for ED nurses'airway airbag management knowledge were 60.26±23.00,belief was 88.65±13.36,and behavior was 75.10±19.84.The main influencing factors of airbag management knowledge included participation in specialized nurse or mechanical ventilation training,department,and work experience in the department.Influencing factors of airbag management belief comprised knowledge,department,and participation in specialized nurse or mechanical ventilation training.Primary influencing factors of airbag management behavior included knowledge,belief,department,participation in specialized nurse or mechanical ventilation training,and professional title.The belief in airbag management among ED nurses acted as a partial mediator between knowledge and behavior,with a total effect value of 0.513,and an indirect effect of 0.085,constituting 16.6%of the total effect.CONCLUSION ED nurses exhibit a positive attitude toward airbag management with relatively standardized practices,yet there remains room for improvement in their knowledge levels.Nursing managers should implement interventions tailored to the characteristics of ED nurses'airbag management knowledge,beliefs,and practices to enhance their airbag management proficiency.